Health Care’s Environmental Footprint

The conversion from paper medical records to electronic medical records should help improve quality of care, reduce duplicative health care spending, and minimize unnecessary visits. But can it save the planet?


Researchers from Kaiser Permanente sought to determine the potential environmental impact due to the conversion from traditional paper medical records to electronic health records. Kaiser’s electronic health record system (t) covers 8.7 million members. Last year, the electronic health record system was implemented in 454 medical offices and 36 hospitals.

Using a complex set of assumptions merged with data about resources used before and after implementation of KP HealthConnect, the researchers could deliver estimates of environmental impact. Specific environmental parameters investigated included greenhouse gases, toxic chemicals, and water use. For most resources, the overall environmental effect was reported as both the quantity used/saved (either by weight, volume, or energy) and the carbon consumed/released from an acreage of forest.

The most obvious way in which the transition to electronic health records reduces the size of health care’s environmental footprint is the direct reduction in paper use. The KP study indicated that 780 tons of outpatient records and 260 tons of inpatient records were eliminated. Therefore, the estimated amount of carbon saved was the equivalent of that sequestered by 4,200 acres of forest over the course of 1 year. Reduction of paper jackets for x-rays, consent forms, and other miscellaneous forms reduced an additional 63 tons of paper, equivalent to the carbon captured by 17 acres of forest.

However, the implementation of computerized records required the production of paper visit summaries (200 tons, 810 acres) and packaging from all the new computers required (70 tons, 283 acres). Nearly eliminating the carbon savings from switching to paper, the use of thousands of perconal computers required 27,300 Megawatts of energy; this is the equivalent of burning 3,800 acres of forest. In addition to this, the energy for KP’s data centers required 62,000 MWh which equates to losing 9,500 acres of forest.

Yet, KP maintains that helps the insurer to prevent doctor visits (approximately 9 to 26 percent of all visits) for simple things such as medication refills or other “marginally effective appointments.” An estimate for the greenhouse gas reduction due to reduced patient travel yielded a savings of 3.3-10 million gallons of gasoline. This means that the carbon savings represent anywhere between 6,400 and 19,200 acres of forest.

Additional estimates suggest that the switch to digital x-rays eliminates large quantities of the toxic chemicals silver nitrate (6.8 tons) and hydroquinone (26.5 tons). Digital x-rays also save 71.5 million gallons of water compared to processing for traditional x-rays.

Commentary

According to recent surveys, nearly use some form of electronic health record system. Some are entirely electronic; others only have partially electronic records (i.e. still requiring some paper records). This research assumes the carbon footprint of the health care industry might be improved by the switch to.

Looking through the itemized estimates of greenhouse gases saved (and produced) reveals that the energy needed to power all the computers for an electronic record system dwarfs the direct reduction in paper products (nearly 10,000 acres lost). What determines whether or not electronic records serve as a net positive or net negative for the environment? Gasoline.

The gasoline saved by KP HealthConnect – by preventing patient travel to and from office visits – provides dramatic carbon savings ranging from 6,400 to 19,200 acres per year. To reach an environmental break even point, 14 percent of outpatient visits (approximately 6.3 million visits) would need to be eliminated. The nation’s health care environmental footprint will not simply decrease by exchanging paper for processors. The data suggest that the greatest impact will come from reducing travel to and from the doctor’s office. Policies (and financial incentives) must be in place to promote technology (email and phone) that can substitute for  routine medical office visits.

Turley, M. et al. Use of Electronic Health Records Can Improve the Health Care Industry’s Environmental Footprint. Health Affairs. 30 (5): 938-946.

by

Cedric Dark, MD, MPH

 

 

 

 

One Reply to “Health Care’s Environmental Footprint”

Comments are closed.